Nursing Practice Today

2023; Volume 10, No 3, pp. 198-207

Tehran University of Medical Sciences

Original Article
Occupational stress and coping strategies of the nursing staff of a Public University Hospital during
the COVID-19 pandemic

Zacharenia Dimitriadou1, Petros Kostagiolas2, Georgios Kritsotakis3, Nikos Rikos4, Areti Stavropoulou5,
Michael Rovithis3*
1
AHEPA University General Hospital, Thessaloniki, Greece
2
Department of Archives, Library Science and Museum Studies, Ionian University, Corfu, Greece
3
Department of Business Administration and Tourism, Hellenic Mediterranean University, Crete, Greece
4
Department of Nursing, Hellenic Mediterranean University, Crete, Greece
5
Department of Nursing, University of West Attica, Athens, Greece

ARTICLE INFO ABSTRACT

Received 20 May 2023 Background & Aim: Nursing staff are exposed to high-stress levels daily due to the
Accepted 29 July 2023 demanding work environment. This study examined nursing staff occupational stress and
coping mechanisms during the COVID-19 pandemic.
Methods & Materials: A cross-sectional study with a sample of 108 nursing staff was
Available online at: carried out. The Expanded Nursing Stress Scale (ENSS), the Brief Coping Orientation to
http://npt.tums.ac.ir Problems Experienced (Brief COPE) Scale, and constructed questions were used for data
collection. Data were analyzed using chi-square (χ2), Pearson methods, and Multiple
linear regression analysis. Statistical significance was determined at p-value ≤ 0.05.
Keywords: Results: Overall Occupational stress was assessed with a mean score of 146.8 (SD±35.3).
nursing staff;
In Brief COPE Scale, a higher mean was assessed for “social support - information
occupational stress;
coping strategies;
seeking” and lower for “substance use” or “withdrawal” (p<0.001). A significant
COVID-19 pandemic difference in response distributions was observed regarding their degree of concern or fear
about COVID-19 (p<0.01). Increased levels of Overall Occupational Stress (ENSS) were
associated with higher levels of BCOPE. Emotional Focus and Venting and Diffusion of
Corresponding Author:
Emotions (β=5.15, p=0.026), younger age of the participants (β=-5.78, p=0.033), years of
Michael Rovithis, Department of Business
working in the healthcare sector (β=14.46, p=0.004) or the highest fear/concern about
Administration and Tourism, Hellenic
being infected and infecting their patients (β=6.22, p=0.032).
Mediterranean University, Crete, Greece Conclusion: Nursing staff experienced moderate levels of occupational stress, while
E-mail: rovithismihail@gmail.com challenges raised by the pandemic were handled through seeking social support, positive
reframing and acceptance, taking protective measures, and turning to religion. Developing
DOI: meaningful administrative and educational strategies for staff empowerment and
10.18502/npt.v10i3.13429 resilience may reduce anxiety and occupational stress for nurses.

Introduction
As part of the working environment, experience when facing excessive workloads
the presence of people and ever-changing data and demands (2). However, this factor is
causes stress. In circumstances where stress subjective because these conditions are a
cannot be handled, it can have ramifications source of stress for some people but not for
for a person’s physical and mental health. others (3).
However, it is crucial to highlight the good Specifically, health professionals,
effects of stress on a person, the most particularly nurses, are more likely to
important of which is their motivation for experience occupational stress (4). Healthcare
growth (1). According to the World Health professions are listed among the top six most
Organization, occupational stress is the stressful jobs, with healthcare personnel, their
psychosocial manifestations workers families, and patients feeling the most

Please cite this article as: Dimitriadou Z, Kostagiolas P, Kritsotakis G, Rikos N, Stavropoulou A, Rovithis M. Occupational stress and coping strategies
of the nursing staff of a public university hospital during the COVID-19 pandemic. Nursing Practice Today. 2023; 10(3):198-207
Copyright © 2023 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International license
(https:/creativecommons.org/licenses/by-nc/4.0/) Noncommercial uses of the work are permitted, provided the original work is properly Cited
 Z. Dimitriadou et al.

detrimental impacts of stress (4). Conditions emotional state by denying and avoiding the
and workload, interpersonal interactions, cycle problem (12). The main strategies for dealing
hours, and lack of personnel are strongly with nurses’ occupational stress are adequate
linked to the onset of occupational stress and logistical and psychological support of nurses,
negative health impacts among nurses (5,6). appropriate and specialized training, and the
These factors have a negative impact on the development of stress management skills and
physical and mental health of nursing staff, as means. Therefore, stress-coping strategies are
well as their productivity and quality of care considered necessary to find alternative ways
(7). Typically, signs of physical and mental to relieve nursing staff (13).
problems, behavioral changes, dysfunctions in Similar studies documented in the
efficiency, burnout, and dissatisfaction among international literature (2,14) highlight the
nursing staff are observed (8). need to improve the working conditions of
In addition to the work factors that health professionals, considering the
might lead to the manifestation of challenging, demanding, and especially
occupational stress, the periodic occurrence of dangerous work environments they encounter
epidemics, such as the COVID-19 pandemic daily, particularly nurses in the current period.
that has plagued the worldwide population Even though occupational stress has
since the end of 2019, also plays a significant been a topic for many years, the special
role. According to recent studies, the primary conditions caused by the pandemic in
source of concern for nurses during the healthcare working environments necessitate
pandemic was the fear of contracting the the need to revisit this issue. In particular,
disease and unknowingly infecting their loved during the Covid-19 pandemic, healthcare
ones (9,10). A high rate of exposure and an professionals, and especially nurses, were
elevated risk of infection with the novel hampered both physically and
coronavirus SARS-CoV-2 place healthcare psychologically, as the increased demands of
professionals on the front lines of the COVID- the healthcare systems, the uncertainty, and the
19 pandemic. Many nurses caring for COVID- radical changes in organizational and clinical
19 patients suffer from burnout or depression, sectors severely increased the levels of work
and many have encountered discrimination stress. In addition, healthcare professionals
outside of the job (9,11). The new data that appeared to cope with this psychological strain
have emerged as a result of the pandemic using various strategies and gain not only
reveal unprecedented conditions for the negative but also positive experiences from the
professional, personal, and social life of the new working conditions (14). For these
nursing staff, while at the same time, they must reasons, it is important to examine, identify
deal with ever-increasing work demands and and understand new evidence on occupational
with repercussions in numerous areas of their stress and the coping strategies used by the
lives, both work-related and non-work-related nursing staff during the pandemic era.
(2).
The aim of this study was to determine
It is thought vital to employ
the levels of occupational stress experienced
approaches and strategies for managing
occupational stress (3). Relevant study of by the nursing staff at a public university
strategies for coping with stress reveals those hospital during the COVID-19 pandemic. In
in which the individual attempts to overcome addition, the researchers intended to identify
the problems and stress-inducing factors by the factors related to occupational stress and
finding and organizing alternative actions (3) the coping strategies employed by the nursing
and those that focus on the management of the staff.

Nursing Practice Today. 2023;10(3):198-207 199

Occupational stress and coping strategies

Methods subscales. Each item is rated on a 5-point Likert

scale ranging from 1, “never stressful,” to 4,
This study was carried out in the
“extremely stressful,” and 0, “does not apply.”
University General Hospital of Thessaloniki,
The following are the subscales: (1) dealing
using a cross-sectional design with partial
with death and dying (seven items with a score
correlations. This specific hospital was selected
range of 0–28); (2) conflicts with physicians
because it is one of the largest hospitals in
(five items with a score range of 0–20); (3)
Greece, with a capacity of 697 available beds,
inadequate preparation to deal with the
covering almost the entire range of medical
emotional needs of the patient (three items with
specialties. Based on a convenience sampling
a score range of 0–12); (4) problems with peers
strategy, a sample of 108 nurses was recruited,
(six items with a score range of 0–24); (5)
consisting of staff nurses and healthcare
problems with supervisors (seven items with a
assistants (HCAs). HCAs are graduates of
score range of 0–28); (6) workload (nine items
public or private occupational training schools
Using subscale scores, an instrument’s total
with one or two years of basic education and
(range: 0–236) score is derived from subscale
hospital-based training prior to employment.
scores. There is no specific score threshold for
HCAs play a supporting role in
the scale and subscales. Higher scores indicate
administering patient care under the
higher levels of perceived stress. For the ENSS
supervision of registered nurses. Most of their
in the current study, the overall Cronbach’s α
duties include sanitary care, feeding, dressing,
was found to be 0.95. The short version of the
grooming patients, and bed preparation. Staff
Coping Orientations to Problems Experienced
nurses are graduates of universities or
(Brief COPE) scale was used to collect data on
technological educational institutes (recently
coping strategies (16), which consists of 30
made equivalent to universities). The basic
questions categorized into 15 subscales and
nursing curriculum in both institutions is a four-
related to the set of strategies that can be
year program, with the eighth semester devoted
applied. The overall Cronbach’s α for the Brief
to clinical practice. Staff nurses are primarily
COPE scale was found to be 0.86. In addition,
responsible for identifying nursing issues and
developing nursing diagnoses. Staff nurses are a questionnaire containing eight questions
responsible for designing, implementing, and about the pandemic, nursing staff contact with
evaluating appropriate patient care sick patients, and the anxiety/fear it causes
interventions, as well as monitoring patients’ based on relevant international literature was
conditions, assessing their needs, and providing distributed (17,18). Specifically, the first three
patient education and counseling. The sampling dichotomous questions concern nurses’
framework and the field of the study consisted interaction with ill patients, and the following
of ten clinics representing the entire spectrum of five concern the fear created by the possibility
adult patient medical and surgical nursing care, of contracting or transmitting the virus. The
including a COVID-19 clinic. The data were participants’ responses were formulated on a
obtained in January 2021. five-point Likert-type scale, with 1 representing
Data were collected by the researchers “Not at all” and 5 representing “Extremely.”
using three anonymous self-report The overall Cronbach’s α obtained in the
questionnaires. The Expanded Nursing Stress current study for the questionnaire concerning
Scale (ENSS) assessed occupational stress (15). the pandemic was 0.74. Finally, questions were
The ENSS consists of 59 items and nine included to collect the sociodemographic and

200 Nursing Practice Today. 2023;10(3):198-207

 Z. Dimitriadou et al.

professional characteristics of the study Version 26.0. Armonk, NY, USA: IBM
participants. Corp). Frequency distributions of the basic
One hundred thirty (130) anonymous characteristics of the 108 participants were
questionnaires were distributed to nurses, while evaluated. Using the method of Blom (QQ
one hundred eight (108) were returned plot), symmetry was calculated for the scores
completed, resulting in a satisfactory response of total occupational stress (ENSS) & Coping
rate (83%). The data were collected in January with Problems (Brief COPE) scales.
2021, and the average time to complete the Correlations between ENSS & Brief COPE
questionnaire was 15-20 minutes. The Scale scores, as well as with the characteristics
researchers informed the Head nurse of each of participants, were performed with Chi-
department about the purpose of the research, to square (χ2) and Pearson method. Multiple
facilitate access to the nursing staff and support linear regression analysis was also used to
recruitment. Researchers approached nurses evaluate the overall dependency of the ENSS
during their shifts, and a mutual decision was with the levels of the Brief COPE and the
taken for the place and the time in order to characteristics of the participants, and both
complete the questionnaires without any unstandardized (β) and standardized (b or
distractions. This process allowed a high betas) coefficients were calculated. Statistical
response rate. significance was determined at p-value ≤ 0.05.
Before the study’s inception, ethical
Results
approval was granted by the Scientific
Committee of the AHEPA University General Of the 108 nurses who participated in
Hospital of Thessaloniki (Ref. 740/21-12- this study, 84.3% were female, and 43.5% were
2020). The participants in the study were aged 45 or older. 62.0% of the participants were
informed about the study objectives, expected married, and 67.6% had children. In respect of
outcomes, and associated benefits and risks. their education, 27.8% were high school,
They did not receive any compensation for their vocational training institute, or hospital school
participation in the study. Informed consent graduates. 48.1% held a bachelor’s degree in art
was received from the participants before they or science, 14.8% a master’s, and 2.8% a Ph.D.
answered the questionnaire. Regarding professional status, 72.2% were
Data were analyzed using SPSS registered nurses, and 27.8% were HCAs
software (IBM SPSS Statistics for Windows, (Table 1).
Table 1. Descriptive characteristics of nurses who participated in the study (n=108)
Variables Ν %
Men 17 15.7
Sex
Women 91 84.3
<35 30 27.8
Age (Years) 35-44 31 28.7
45+ 47 43.5
Married 67 62.0
Marital status
Single, Divorced, Widowed 41 38.0
Yes 73 67.6
Children
No 35 32.4
Graduate of vocational training Institute 30 27.8
/Hospital school/High school
Education level University 59 54.6
Master’s degree 16 14.8
PhD 3 2.8
Registered nurse 9 72.2
Profession
Healthcare assistants HCAs 30 27.8

Nursing Practice Today. 2023;10(3):198-207 201

Occupational stress and coping strategies

The ENSS defines 9 stress factors or and lower for “substance use” or “withdrawal”
subscales; total occupational stress (anxiety) (p<0.001).
was assessed with a mean score of 146.8 Regarding their degree of concern or
(SD±35.3); however, there are no clear
fear about COVID-19 (Table 2), a significant
bibliographic cut-offs for determining stress
difference in response distributions (p<0.01)
levels.
was observed in five questions/sentences, with
The mean values of responses to the 15
factors of the Brief COPE Scale differ a significant difference in the gradation of
significantly (p<0.001), with higher mean responses from “not at all” to “extremely”
levels for “social support- information seeking” concerned.

Table 2. Items concerning the COVID-19 pandemic of the 108 nurses in the study
Not at all A little Somewhat Quite a bit Extremely
Items
(%) (%) (%) (%) (%)
I am afraid of contracting COVID-19 12.0 28.7 27.8 18.5 13.0
I am afraid of transmitting COVID-19 to my family
0,0 10.2 17.6 23.1 49.1
and friends
I am afraid of being quarantined 36.2 25.9 19.4 10.2 8.3
I am afraid of infecting my colleagues 9.3 13.0 27.7 23.1 26.9
I am afraid of infecting my patients or their families 8.3 11.1 32.4 18.5 29.7

Only positive significant correlations Turning to religion (r=0.275, (p=0.001). In

are identified between the ENSS and Brief addition, there is a significant correlation
COPE subscales (Table 3). Increases in total between anxiety about “contact with death”
occupational stress are associated with parallel and procrastination (r=0.363, (p=0.001),
increases in Taking protective measures anxiety about “workload” and religion
(r=0.345,p=0.001), Planning (r=0.198, (r=0.357), (p=0.001), and anxiety about
p=0.001), Procrastination (r=0.342, p0.001), “uncertainty concerning treatment” and taking
Self-restraint (r=0.202, (p=0.001), and protective measures (r=0.380, (p=0.001).

Table 3. Correlation of Expanded Nursing Stress Scale with Brief Coping Orientation to Problems Experienced Scale of study
participants
concerning treatment
needs of patients and
handle the emotional

3) in discrimination

patients and their

6) in conflict with

7) in conflict with

8) in conflict with

9) in conflict with
1) in contact with

2) in insufficient

4) in workload
preparation to

5) uncertainty
their families

Coping strategies
Total stress

physicians

colleagues

superiors

families
death

r – Pearson
Taking protective
0.345* 0.275* 0.131 0.125 0.339* 0.380* 0.263* 0.262* 0.194* 0.236*
measures
Planning 0.198* 0.215* 0.082 -0.003 0.286* 0.213* 0.077 0.083 0.068 0.181

Procrastination 0.342* 0.363* 0.233* 0.077 0.351* 0.330* 0.132 0.228* 0.171 0.344*

Self-restraint 0.202* 0.231* 0.024 0.146 0.186 0.321* 0.089 0.172 0.077 0.034
Social support-
0.293* 0.260* 0.100 -0.003 0.282* 0.326* 0.168 0.200* 0.284* 0.224*
information seeking
Emotional, social
0.281* 0.224* 0.130 0.030 0.281* 0.207* 0.102 0.289* 0.230* 0.297*
support
Positive reframing 0.078 0.040 0.151 0.033 0.087 0.142 0.066 0.072 -0.057 0.047

202 Nursing Practice Today. 2023;10(3):198-207

 Z. Dimitriadou et al.

Acceptance 0.168 0.085 0.020 0.171 0.128 0.224* 0.044 0.089 0.095 0.189
Turning to religion 0.275* 0.332* 0.279* 0.149 0.357* 0.126 0.174 0.252* 0.111 0.152

Emotional focus and

0.266* 0.264* 0.133 -0.048 0.300* 0.130 0.034 0.215* 0.332* 0.315*
venting

Denial 0.293* 0.237* 0.254* 0.108 0.325* 0.237* 0.171 0.263* 0.280* 0.111

Resignation 0.224* 0.144 0.235* 0.199* 0.154 0.172 0.151 0.259* 0.162 0.135

Mental detachment 0.139 0.127 0.052 0.085 0.134 0.219* 0.008 0.098 0.050 0.111

Substance use 0.131 0.130 0.157 0.041 0.124 0.056 0.063 0.214* 0.093 0.038

Humor 0.131 0.059 0.162 0.057 0.126 0.109 0.071 0.171 0.087 0.117
* p<0.001

Finally, in Table 4, high ENSS scores In summary, total occupational stress

are associated with higher levels of Brief appears to be strongly related to nurses’ ability
COPE Emotional Focus and Venting and
Diffusion of Emotions (β=5.15, p=0.026), to express their emotions, their youth, the
younger ages of the participants (β=-5.78, burden of years spent working in the
p=0.033), the most years of working in the healthcare industry, and the current fear that
healthcare field (β=14.46, p=0.004) or the
they may unintentionally infect their patients if
highest fear/concern about being infected and
infecting their patients (β=6.22, p=0.032). they contract the COVID-19 virus.

Table 4. Multiple linear regression of Expanded Nursing Stress Scale Total Stress with Brief Coping Orientation to Problems
Experienced Scale and its specific characteristics

Total Stress (ENSS)

Prognostic factors Unstandardized 95% confidence Standardized
P-value
coeff. (β) interval coeff. (b)
BCOPE Scale
Taking protective measures 3.88 -2.46 10.22 0.156 0.227
Planning -0.25 -4.71 4.20 -0.013 0.910
Procrastination 3.51 -2.56 9.58 0.128 0.253
Self-restraint 2.18 -3.15 7.51 0.089 0.419
Social support - information seeking -1.18 -7.30 4.93 -0.049 0.702
Emotional, social support -0.54 -5.60 4.53 -0.024 0.834
Positive reframing 1.99 -2.93 6.90 0.086 0.424
Acceptance 0.62 -4.28 5.52 0.026 0.802
Turning to religion -0.37 -4.17 3.44 -0.021 0.849
Emotional focus and venting 5.15 0.63 9.66 0.217 0.026
Denial 2.04 -3.43 7.51 0.082 0.460
Resignation 5.03 -0.55 10.60 0.187 0.077
Mental detachment -5.92 -11.99 0.15 -0.242 0.056
Substance use 0.37 -4.92 5.66 0.015 0.890
Humor 1.08 -3.21 5.38 0.054 0.617
Sex (1: Men, 2: Women) 17.03 -2.81 36.88 0.173 0.091
Age (Year categories) -5.78 -11.08 -0.48 -0.317 0.033
Profession (1: Registered Nurse, 2: Technological education, 3:
1.26 -10.12 12.64 0.020 0.826
Assistant Secondary education)
I am afraid that if I get infected,
Questions concerning the I will infect my patients (1: not at
6.22 0.56 11.88 0.222 0.032
COVID-19 pandemic all 2: a little 3: Somewhat 4:
quite a bit 5: Extremely)
R2 (adjusted) 0.459 (0.301)

Nursing Practice Today. 2023;10(3):198-207 203

Occupational stress and coping strategies

Discussion
The present study investigated the level subscales, including “contact with death,”
of occupational stress and coping mechanisms “workload,” and “conflicts with
of the nursing staff at a public university colleagues/supervisors.”
hospital during the COVID-19 pandemic. Regarding the adoption of coping
According to the present study’s findings, the strategies, “social support-information seeking”
nursing staff experienced moderate levels of was found to be prevalent, while “positive
occupational stress. Similar results were reframing” and “taking protective measures”
highlighted by a relevant study that has been were found to be relatively prevalent. In
contacted before the pandemic (19). contrast, “resignation” and “substance use”
In our study, the most prevalent were at low levels among nurses. These results
stressors were “uncertainty concerning are supported by a study with a sample of 160
treatment,” “workload,” “conflicts with nurses from hospitals in two major cities in
patients and their families,” and “contact with Greece (26). The contribution of social support
death.” The least frequent stressors were appears to have a significant impact not only on
“discrimination” and “inadequate training to preventing the emergence of occupational
meet the emotional demands of patients and stress and emotional exhaustion but also on
their families.” This result confirmed prior mitigating the impacts of stress-inducing
research findings that measured Greek nurses’ mechanisms. The results of a study (27)
occupational stress using the ENSS (20). including 325 nurses in hospitals in the
Similar findings are presented by relevant Philippines and another of 444 nurses in three
studies (21, 22), which also identified dealing hospitals in China (28) revealed that a high
with death, uncertainty concerning treatment, degree of social support as a coping mechanism
workload, and conflicts with patients as the was associated with lower levels of nurses’
most significant stressors in the work stress.
environment of nurses. In contrast to the above Consequently, comparing the Brief
studies, a study conducted on primary care COPE subscales and the unique features of the
nurses in Hong Kong (23) found that dealing participants, it is observed that the female
with the death of a patient is a less common gender is associated with high rates of
source of stress for nurses. “Procrastination,” “Emotional-Social Support,”
Based on the connections between the and “Turning to Religion.” Additionally,
ENSS subscales and the unique characteristics unmarried nursing staff are associated with high
of the participants, the present study found that “Resignation” rates, but more years of health
occupational stress affects both sexes, but their professional experience are associated with a
responses to stressful conditions may differ. high “Planning” score.
Men react more dynamically and energetically Regarding the results of the questions
to stressful events than women, according to about the COVID-19 pandemic, a large
research (24). Moreover, women assume proportion of respondents are “somewhat” to
multiple roles as employees, mothers, and “extremely” afraid of transmitting COVID-19
housewives; hence, they demonstrate more to the patients they care for. In contrast, 36.1%
resilience and adaptability to stressful are “not at all” fearful about entering a
conditions (25). In addition, in the current quarantine regime. The foregoing results are
study, the number of years spent working in also confirmed by the findings of a similar
the health sector or in the existing position is study (29) conducted in primary care settings
positively associated with most stress for doctors and nursing staff in Singapore,

204 Nursing Practice Today. 2023;10(3):198-207

 Z. Dimitriadou et al.

which revealed that nurses and doctors were sample size and non-probability sampling
extremely concerned and fearful about the strategy, will contribute to the expansion of
prospect of COVID-19 transmission to their knowledge in this particular field.
loved ones. Similar results were found in a
Conclusion
study of 263 healthcare personnel who had
contact with confirmed cases of COVID-19 in The study indicated that nursing
Mexico, where their fear over the possibility of personnel experienced moderate levels of
transmitting the coronavirus to their family occupational stress. The nursing staff coped
was identified as the most significant reason with challenges by seeking social support,
for moderate to high stress (30). positive reframing, and acceptance, taking
The notion that they encounter protective measures, and turning to religion.
individuals who are ill and require Most respondents feared that if they
hospitalization correlates with more night, contracted COVID-19, they would transmit it
evening, and weekend shifts in the last month. to family/friends and patients.
This could be interpreted as due to the nurses’ By translating these findings into
belief that the duration of coronavirus practice, nurse leaders may develop
exposure is prolonged by shifts and years of meaningful administrative and educational
duty. strategies aiming at staff empowerment,
Finally, through the multiple linear resilience, self-care, and well-being during
regression of all three tools (ENSS, Brief periods of increased healthcare demands. This
COPE, and questions about the COVID-19 can be accomplished via stress management
pandemic), it was determined that Total Stress learning strategies and constructive and
appears to be directly related to the nurses’ supportive management. Creating a positive
ability to focus and release their emotions, working environment, educating and
their young age, their exhaustion caused by providing information about patient safety,
working for many years in the healthcare offering counseling, and creating a supportive
sector, and their concern of transmitting network within the workplace can be proved
COVID-19 to their patients. A possible beneficial for nurses in terms of anxiety
explanation could be that young age may be control and reducing levels of occupational
associated with elevated levels of anxiety and stress.
concern about the pandemic due to a lack of
hospital-based work experience, which Conflicts of Interest
suggests uncertainty over adherence to The authors declare that they have no
personal safety measures. known competing financial interests or
This study reached important personal relationships that could have
conclusions; nonetheless, a weakness of the appeared to influence the work reported in this
research was the sampling technique (non- paper.
random sampling) and the limited sample
size in a public tertiary hospital in a specific Acknowledgment
region of Greece. Therefore, the findings
cannot be generalized to the overall nursing The authors would like to express their
population in Greece. Further research is gratitude to all the participants of the study.
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